Provider Demographics
NPI:1871835876
Name:HEDGECOCK, JON PACKARD (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:PACKARD
Last Name:HEDGECOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 DIAMOND PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4321
Mailing Address - Country:US
Mailing Address - Phone:816-561-3003
Mailing Address - Fax:
Practice Address - Street 1:1950 DIAMOND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4321
Practice Address - Country:US
Practice Address - Phone:816-561-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-42361207X00000X
CT60366207X00000X
MO2019024768207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery